The people who go to Bert te Wildt's psychosomatic clinic are constantly tense, constantly stressed out. Everything in their lives feels like work. But they soldier on. Te Wildt's patients suffer from a new form of chronic stress-induced depression that he calls burn-on. In this interview, te Wildt explains why so many people have such a hard time switching off.
I enjoy taking a step back from this busy world of ours and going to a quiet place where I feel nurtured. I like working hard. I've been working on building the clinic on Lake Ammer for a number of years. But I go to the monastery because I think it's important to find a balance between your work life and your private life. My time out at the monastery gives me inner peace.
Many of our patients come to us with work-related conditions. Burnout is a condition that is quite well know, and happens when people have a breakdown as a result of acute stress-induced depression. But what we're seeing more and more these days is a different phenomenon that we refer to as burn-on. People with his condition come to us after years or even decades of being chronically overworked, exhausted and depressed. They hide their suffering behind a smile and grit their teeth. They are often highly disciplined individuals.
With burn-on, depression is hidden. Chronic exhaustion doesn't explode like burnout.
They know that burnout can be a problem for some people. But despite being chronically exhausted, they keep their spirits up - on the surface, at least - by making small adjustments to their professional and personal lives, and keep soldiering on. When they're admitted to our clinic, they say: "I'm fine, I'm not depressed, I love my life and my job - I was still working last night. I'm here to get back on my feet as quickly as possible and start functioning normally again." But ten minutes later, they tell us they sometimes have suicidal thoughts.
With burn-on, the depression is hidden. The chronic exhaustion doesn't come to a head explosively like it does in the case of burnout. People suffering from burn-on are constantly pushing their limits to perform at work, they want to function.
Everything is stressful. They're hyperactive, but at the same time, they feel paralysed and are numb to the warning signs their body and soul are sending them. People have forgotten how to connect with feelings such as sadness, fear and anger.
People suffering from burn-on are very tense, and it's that tension that prevents them from imploding or collapsing. It often manifests itself in the body, so they might have tense shoulder girdle, throat and neck muscles, which can often lead to headaches. Some patients have displaced vertebrae and herniated discs. Others have very high blood pressure. Many people have head-related symptoms such as tinnitus or problems relating to the jaw, such as grinding their teeth. While they're at the clinic, a lot of people become aware of a sense of emptiness and defeat, and that they lack drive and interest. They often experience feelings of guilt and shame, and have difficulty concentrating and sleeping.
Being a workaholic is a typical path to burn-on, because work gives them a high that keeps them going for a very long time. But their addiction masks the fact they've forgotten how to enjoy themselves in other contexts. They start operating in work mode in all areas of their life; their whole life becomes work-like. For example, they're always results-orientated, efficient, constantly ticking things off their to-do lists. They stop asking themselves whether they still enjoy doing things in their free time. Meeting up with friends and family becomes a chore, an obligation they have to meet. They're unable to spend a relaxed moment in the here and now, they no longer have time to sit back and reflect.
Work is a great part of life, and being passionate about it is great too. Work has the ability to stimulate our inner reward system, and that's what gives us that high. I don't need to explain why people get addicted to alcohol or cocaine. So, let's consider sex and sports for a moment. People can become addicted to these activities because of the endorphins they release in the body, such as adrenaline. But when it comes to work and earning money, the reward system is more abstract. That's because there are many different kinds of work - there's work that is more physical and then there's more cognitive work. Work can give rise to a lot of different kinds of rewards: money, praise and recognition, to name a few. Some of these rewards are quantifiable, for example, it makes me happy to see that the number of employees who work at my clinic is growing - or that my salary has increased.
People who have a lot of responsibility for other employees. And people whose work involves caring for others, such as educators, doctors and psychotherapists. But the people who are most affected are people who work in the private sector.
For example, successful managers who spend years building a start-up and suddenly ask themselves: "Why am I doing this?" Who say to themselves: "I'm really successful, but I'm not enjoying my life, I don't know how to get myself out of this situation, I've missed out on life." Or family business owners - one of the biggest problems we see in this group is a lack of boundaries between work and their private life.
People in top management positions often feel they're not doing enough - even though they are accomplishing a lot. The same applies in their private lives. They might think that they're not at home enough, and don't have enough time for their children or friends. They're often plagued by a persistently guilty conscience. And they hardly ever take a moment for themselves. This strong sense of being responsible for everything prevents them from dedicating half a day or an evening to themselves.
The Kloster Diessen psychosomatic clinic is located in a former convent. Founded six years ago, it now has 135 employees and space for around 90 patients - who come from a variety of professional backgrounds and include managers, management consultants, actors and doctors.
Many things can contribute to chronic exhaustion, like being constantly reachable on apps and smartphones, and being able to work from anywhere at any time. In a lot of workplaces, the workload is increasing but there are fewer people to do the work. Many employees have to deal with back-to-back meetings and are juggling tight deadlines. We are also seeing people come under increasing pressure because we're being taught to be more competitive. Just look at the countless reality shows that feature young people competing against each other. I find them horrifying. Only one person can win, only the strongest survives. This same thirst for competition is all over social media and computer games like Fortnite. And so ultimately, we also find it in the workplace, with people using their elbows to get what they want and constantly pushing their limits or trying to outperform others at work.
You're right. We're currently seeing a countermovement that's making us realise that things have to change. It's possible that exhaustion-related illnesses such as burnout will become less common when Generation Z starts to become more prevalent in the workforce. Having said that, there are also a lot of extremely ambitious Gen Zedders out there who want to earn lots of money, have a high-status job and live in luxury. Incidentally, I really don't like the term work-life balance.
Ask yourself what values should guide you and serve as your compass for a good life?
Because people act as if we are only really living when we are engaging in our private life and leisure time - that somehow work isn't part of living. People are so exhausted and have become so alienated from work processes that we no longer see our work as a part of our lives. I think that's dangerous: we should enjoy our work and make it worthwhile for ourselves and others.
You experience moments of connectedness. In other words, you feel connected to what you do, and to the people you do it with and for. It doesn't matter whether you're an entrepreneur, an artist or a cashier. If your work is good for you, it gives you a sense of gratification and purpose. You know that when you've achieved a specific goal, you have done well. In psychology, we call that feeling the "moment of now" - it's a feeling of being in the here and now, of being at one with everything. Some people refer to it as flow; a state you reach when you've been working hard on something for a few hours and are completely absorbed in it.
Ask yourself what's really important to you. Which values should guide you and serve as your compass for living a good life. Are they values such as partnership, career, children, family, education, environment, spirituality, culture or relaxation? And then ask yourself: Is that how I'm living? The moment when you answer that question can be a terrifying one.
This exercise can motivate you and encourage you to say to yourself: "I really need to change something in my life." When our patients go back home, we often tell them to ask themselves whether they have any specific times, places or situations that they dedicate to themselves, that they can use to make themselves feel good. Many people lose their sense of self, and stop taking care of themselves. You need to take time for yourself, every day, every weekend - not just when you're on block leave.
But often to such an extreme that the activity itself becomes stressful. Some of our patients spend their downtime at the clinic cycling around Lake Ammer. Or they jog until they're exhausted. They find it almost impossible to switch off. Other people are continuously consuming information via the media, or wear headphones and are surrounded by background noise all day. These days, you have to work really hard if you want to take a step back from all the over-stimulation we're exposed to.
Dr Bert te Wildt (55) is a psychiatrist and psychotherapist, and Head Physician at the Kloster Diessen psychosomatic clinic on Lake Ammer, near Munich. His clinical and scientific focus includes behavioural addictions, internet addiction and stress-related mental illnesses. In 2021, he and his colleague Timo Schiele published the book "Burn On: Immer kurz vorm Burn Out" ("Burn On: Always on the brink of a burnout").
Michael Neubauer is a journalist at Badische Zeitung in Freiburg im Breisgau.
